Endoscopic ultrasound-guided pancreatic duct drainage (EUS-PD) is considered as a feasible alternative to surgical or percutaneous drainage in patients with pancreatic ductal (PD) obstruction in whom endoscopic retrograde pancreatography (ERP) has been unsuccessful. Initially described in 2002, 1 EUS-PD can be divided into two distinct techniques, namely, EUS-guided pancreatic transmural stenting (EUS-PTS) and rendezvous (EUS-RV). EUS-PD facilitates access to the main PD (MPD) and deploys a stent transmurally (EUS-PTS). However, when the duodenoscope can be advanced to the level of the ampulla, it is preferable to attempt an EUS-RV. EUS-RV enables ERP by puncturing the MPD transmurally and advancing the guidewire in an antegrade manner up to the duodenum. While many reports have described the EUS-PD procedure, there is no universal consensus on the optimal strategy to perform EUS-PD. This review focuses on the current status, indications, techniques, and outcomes of EUS-PD, especially EUS-PTS. INDICATIONS FOR ENDOSCOPIC ULTRASOUND-GUIDED PANCREATIC DUCT DRAINAGE The possible indications for EUS-PD are shown in Table 1. Generally, difficulty in transpapillary treatment and lack of a proper approach to the major papilla owing to a reconstructed intestinal tract post-operation are considered as major indications for EUS-PD. The most common underlying diseases are chronic pancreatitis and stenotic pancreaticojejunostomy. 2-6 In addition, rare diseases such as MPD rupture after acute pancreatitis or trauma, pancreatic cancer, and cholangiocarcinoma